Research in Community and Public Health Nursing

Original Articles

Gender Differences in Older Adults’ Muscle Strength and Depressive Symptoms: A Relationship Mediated Through Perceived Stress: Gyeong A Kang, Jihye Shin, Ju Young Yoon; Res Community Public Health Nurs. 2023;34(3):196-204. Published online September 27, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00164

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Abstract PDF: Purpose
Preventing the effects of physical vulnerability is a practical approach to improving older adults’ depressive symptoms. This study aims to examine the relationship between gender differences related to muscle strength and depressive symptoms mediated by perceived stress.
Methods
In this cross-sectional study, data from 2,705 older adults (65 years old or older) from the Korea National Health and Nutrition Examination Survey VII 2016 and 2018 were analyzed. The moderated mediation model was developed; the outcome, independent, mediation, and moderated mediation variables in the literature-based research model were depressive symptoms, muscle strength, perceived stress, and gender, respectively.
Results
Perceived stress had a mediating effect on the relationship between muscle strength and depressive symptoms. The indirect effect of muscle strength on depressive symptoms mediated by perceived stress was β = -.02 (95% CI:-0.03~-0.01). The moderated mediation model demonstrated that the interaction term of handgrip strength and gender negatively affected perceived stress, which indicated that gender moderated the mediating model of perceived stress on the association of muscle strength and depressive symptoms (β = -.01, p <.05). The conditional indirect effect model was insignificant in the male group (β = -.00, 95% CI:-0.01~0.01) but significant in the female group (β = -.01, 95% CI: -0.02~0.00). Conclusions: Perceived stress mediated the relationship between muscle strength and depressive symptoms. However, the effect differed by gender. A stress-mediated depressive symptoms intervention program for older adults should be developed to consider women’s needs.

Needs assessment of community health practitioners for community care competency of older adults: Na Bee Yoon, Hyeon Kyeong Lee, Haesun Lee, Sang Woo Park; Res Community Public Health Nurs. 2023;34(1):32-42. Published online March 31, 2023; DOI: https://doi.org/10.12799/rcphn.2022.00360

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Abstract PDF: Purpose
To identify needs and priorities of community care competency for older adults among community health practitioners. Methods: Data were collected from a convenient sample of 326 community health practitioners using an online questionnaire, which included items on community care competencies and personal characteristics. Items were developed through literature review, consultation meeting, content validity verification, and preliminary investigation. The data were analyzed using the t-test, one-way ANOVA, and Scheffe’s test with SPSS 25.0. The analysis of needs and priorities was conducted by using the Borich needs assessment and the Locus for focus model. Results: Three competencies have been identified as high-priority needs; ‘Linkages with resources’, ‘Education to others’, ‘Leadership and management’. Conclusion: The findings of this study indicate the need to develop an educational program for community health practitioners to strengthen community care competencies. The programs will need to be provided, especially for young community health practitioners, to ensure that they are well equipped to care for community-dwelling older adults living in rural areas.

Validation of Types of Body Pain Areas and Related Factors in the Korean Aged Using Latent Class Analysis: Sang Ye Shin, Eun Suk Lee; Res Community Public Health Nurs. 2023;34(1):22-31. Published online March 31, 2023; DOI: https://doi.org/10.12799/rcphn.2022.00290

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Abstract PDF: Purpose
The purpose of this study is to find a nursing intervention plan by classifying the body pain areas of the Korean aged and analyzing related factors. Methods: This study performed the latent class analysis, cross-analysis, and one-way ANOVA using the SPSS 25, M-plus 7.0 program on 4,388 older adults aged 65 or over using the data from the 2020 Aging Research Panel. Results: As a result of the Latent Class Analysis, participants divided into four groups. Group 1 was the 'shoulder and low back pain group' with high shoulder and back pain, group 2 was the 'upper body pain group' with severe pain in the arms, wrists and fingers and chest, group 3 was the 'lower pain focused group' with high pain in the legs and knees, and finally, group 4 was the 'general low pain group' with low pain overall. The result of the study shows that the group that did not exercise regularly, the female group, and the low socioeconomic status group have more pain in general. The upper body central pain group showed a low level of life satisfaction. Conclusion: This study discusses various nursing interventions for the prevention of chronic pain, especially for the aged female group who has diverse body pain areas, the aged with low socioeconomic status, and the aged who do not exercise.

Factors Associated with Fear of Falling by Fall Experience in the Community-dwelling Elderly: Yeong Mi Seo, Eun Sook Lee; Res Community Public Health Nurs. 2023;34(1):12-21. Published online March 31, 2023; DOI: https://doi.org/10.12799/rcphn.2022.00199

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Abstract PDF: Purpose
This study aimed to identify factors associated with fear of falling(FOF) by fall experience in the community-dwelling elderly. Methods: Multivariate logistic regression with complex samples was used to analyze the data of 74,475 elders aged 65 and over from the Community Health Survey in 2019. Results: Factors associated with FOF included gender, age, education level, smoking, high-risk drinking, physical activity, stress, depression, cognitive impairment, subjective health status, hypertension, and diabetes mellitus in the non-fall group. In the single fall group, the associated factors were gender, age, physical activity, stress, depression, cognitive impairment, and subjective health status. Related factors in the recurrent fall group included gender, age, physical activity, cognitive impairment, and subjective health status. Conclusion: The study’s findings suggest that it is necessary to develop different strategies to prevent FOF by understanding the contributing factors of FOF in each group of fall experience.

The Mediating Effect of Acceptance Action in the Relationship between Diabetes Distress and Self-stigma among Old Adults with Diabetes in South Korea: Hye Sun Kim, Ka Woun Seo; J Korean Acad Community Health Nurs. 2022;33(4):446-455. Published online December 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.4.446

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Purpose
This study investigated the mediating effects of acceptance action on the relationship between diabetes distress and self-stigma in older adults with diabetes. Methods: A descriptive research approach was adopted using 187 patients diagnosed with diabetes mellitus by an endocrinology doctor. The data were collected from 26 to 31 March, 2020 and were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficient analysis, and hierarchical multiple regression. Results: The mean scores for diabetes distress, self-stigma, and acceptance action were 2.98±0.64, 2.54±0.74, and 4.16±0.35, respectively. Acceptance action partially mediated the relationship between diabetes distress and self-stigma (z=1.98, p=.024), with an explanatory power of 51.0%. Conclusion: To reduce diabetes self-stigma among old adults in diabetes distress situations, it is necessary to improve their acceptance action and develop step-by-step differentiated acceptance action enhancement programs through multidisciplinary collaborations.

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The relationship between stigma and psychological distress among people with diabetes: a meta-analysis
Xiajun Guo, Sijia Wu, Haishan Tang, Yuanyuan Li, Wanglin Dong, Guangli Lu, Shuang Liang, Chaoran Chen
BMC Psychology.2023;[Epub] CrossRef

Factors Associated with Depression in Older Adults Living Alone during the COVID-19 Pandemic: Eun Hye Hong, Kyung Hee Lee; J Korean Acad Community Health Nurs. 2022;33(4):418-431. Published online December 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.4.418

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Abstract PDF: Purpose
The aims of this study were to examine the rate of depression among older adults living alone and to identify factors associated with depression in older adults living alone during the COVID-19 pandemic. Methods: A secondary data analysis was performed using data from the 2020 Korea Community Health Survey. The study participants were 18,824 older adults aged 65 years and over living alone. The data of the complex sample design was analyzed with consideration for weights, stratification, and clustering. Complex sample multiple logistic regression was conducted to identify factors associated with depression in older adults living alone during the COVID-19 pandemic. Results: The results showed that the rate of depression in older adults living alone was 6.3%. Older adults living alone with decreased physical activity, decreased hours of sleep, and an increased or similar frequency of meeting with friends or neighbors were found to be more likely to have depression. In terms of factors related to the practice of COVID-19 infection prevention and control rules, not disinfecting regularly and not wearing a mask indoors were related to depression. For health-related factors, fair or poor self-rated health status, not having breakfast every day, and feeling stressed were related to depression. Conclusion: It is recommended to develop tailored interventions to prevent depression among older adults living alone by considering the factors related to their depression during the COVID-19 pandemic.

Factors Related to Long-term Hospital Length of Stay and Opinions on Discharge-related Community-based Medical and Welfare Service on Elderly Patients with Chronic Diseases in Korean Veterans Hospitals: Young Mi Yoon, Jin Hee Park, Moon Sook Hwang; J Korean Acad Community Health Nurs. 2022;33(4):357-371. Published online December 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.4.357

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Abstract PDF: Purpose
This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

The Effects of Non-pharmacological Interventions on Sleep among Older Adults in Korean Long-term Care Facilities: A Systematic Review and Meta-analysis: Sun Ok Jung, Hye Young Kim, Eun Ju Choi; J Korean Acad Community Health Nurs. 2022;33(3):340-355. Published online September 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.3.340

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Abstract PDF: Purpose
This study aimed to examine the effects of non-pharmacological sleep intervention programs in improving sleep quality among older adults in long-term care facilities. Methods: A literature search and selection was performed on nine different databases using the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Overall, 14 studies met the inclusion criteria and were systematically reviewed. For the metaanalysis, the effect size was estimated using the random-effects model in Review Manager (RevMan) desktop version 5.4 of the Cochrane Library. Results: The meta-analysis of overall non-pharmacological interventions obtained a total effect size of 1.0 (standardized mean difference [SMD]=1.0, 95% confidence interval [CI]: 0.64~1.35), which was statistically significant (Z=5.55, p<.001). The most frequently studied non-pharmacological intervention was aroma therapy, with an effect size of 0.61 (SMD=0.61, 95% CI: 0.14~1.08), which was statistically significant (Z=2.55, p=.010). In the subgroup analysis, group-based interventions, interventions for >4 weeks, and untreated control studies were more effective. Conclusion: This study confirms that non-pharmacological interventions are effective in improving sleep quality among older adults in long-term care facilities. However, the sample size was small and the risk of bias in assessing the interventions of individual studies was unclear or high, thereby limiting the generalizability of the results. Further reviews that evaluate randomized control trials, evidence-based interventions that consider older adult participants' physical activity levels, different intervention methods and durations, and different control group intervention types are needed to obtain more conclusive evidence.

Family and Community Factors Associated with Life Satisfaction of the Urban Community-dwelling Elderly across Age Groups: Focusing on the Importance of Social Capital: Hyeon Sik Chu, Han Yi Lee; J Korean Acad Community Health Nurs. 2022;33(2):207-216. Published online June 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.2.207

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Abstract PDF: Purpose
The aim of this study was to identify differences and influencing factors in the level of life satisfaction among the urban community-dwelling elderly by age group. Methods The study was conducted utilizing the secondary data of 2017 Seoul Survey in a cross-sectional design. Of 42,688 participants in total, the data of 7,927 adults aged 65 or older were analyzed. The data were analyzed using descriptive statistics, independent t-test, chi-square test, Pearson’s correlation coefficients, and multiple linear regression. Results There were significant differences between age groups, and it was found that the old elderly groups had significantly higher life satisfaction than the oldest elderly group (t=8.37, p<.011). In common, family and community factors influencing life satisfaction in the two age groups were companion animals (old elderly: β=.03, p=.002; oldest elderly: β=.06, p=.021), social network (old elderly: β=.10, p<.001; oldest elderly: β=.08, p=.008), and social support (old elderly: β=.05, p<.001; oldest elderly: β=.08, p=.005). Conclusion Based on these results, social welfare and nursing care services focusing on social capital and age group-specific interventions are needed to improve life satisfaction of the elderly. This study might provide the possibility and evidence for a program to improve life satisfaction for the urban community-dwelling elderly, including social capital elements.

Influencing Factors on Health-related Quality of Life among Japanese Middle-aged Marriage-based Immigrant Women in South Korea: A Cross-Sectional Study: Keiko Asami, Duck Hee Chae; J Korean Acad Community Health Nurs. 2022;33(2):188-195. Published online June 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.2.188

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Abstract PDF: Purpose
With the first generation of marriage-based immigrant women in East Asia now reaching their middle or old age, the need to focus investigations on their health-related quality of life has arisen. This study aimed to examine the extent to which physical and mental health, and psychosocial variables can predict health-related quality of life among Japanese middle-aged immigrant women. Methods This study has a descriptive cross-sectional design. A convenience sample of 197 Japanese middle-aged marriage-based immigrant women from two regions of South Korea were recruited between December 2017 and March 2018. Participants completed self-administered questionnaires on health-related quality of life, menopausal symptoms, depression, perceived health status, disease morbidity, social support, and acculturation. The data were analyzed using hierarchical multiple regression. Results Depression was the strongest predictor of health-related quality of life, followed by perceived health status, social support, and household income. Menopausal symptoms, presence of disease, and acculturation appeared to have no additional impact on participant’s health-related quality of life. Conclusion In times of rapid growth of global migration and the aging of immigrants in new destination countries, nursing interventions and public health policies for aging marriage-based immigrant women should be prioritized to improve their mental health by facilitating social support and disease management. In addition, social and employment policies that can help immigrant women transition to a healthy midlife are needed.

The Effect of Instrumental Activities of Daily Living and Depression on the Life Satisfaction of the Elderly Living Together during the Daytime in the Rural Areas: Jin Kim, Jeong In Bae, Nam Hyun Cha; J Korean Acad Community Health Nurs. 2022;33(1):96-104. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.96

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Abstract PDF

Purpose
The purpose of this study is to identify the factors affecting the life satisfaction during the communal life of the elderly in rural areas.
Methods
A total of 143 subjects were selected through convenient sampling. Data were collected in self-reporting questionnaires from 1 August to 30 August 2019. The data were analyzed with SPSS/WIN 23.0.
Results
The Instrumental Activities of Daily Living (IADL) was significantly different according to age, education, and cohabitation. Depression was significantly different according to gender, age, education, and cohabitation. Life satisfaction was significantly different according to age, education, religion, and cohabitation. There was a positive correlation between Instrumental Activities of Daily Living and depression, except for life satisfaction. 41.0% of life satisfaction was explained by depression, religion, and IADL.
Conclusion
The results of this study may be useful in understanding the life satisfaction level of elderly communal life and developing more specific programs for mental activity programs, and depression management strategies are required.

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Dual Mediating Effect of Electronic Device Utilization and Life Satisfaction on the Relationship between Instrumental Activities of Daily Living and Depression in Older Adults
Hwa-Soo Koong, Mihye Lim, Kawoun Seo
International Journal of Environmental Research and Public Health.2022; 19(17): 10617. CrossRef

Identifying Trajectories of Health-related Quality of Life in Mid-life Transition Women: Secondary Data Analysis of Korean Longitudinal Survey of Women & Families: Mi Seon Son; J Korean Acad Community Health Nurs. 2022;33(1):74-83. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.74

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Abstract PDF

Purpose
The purpose of this study was to identify latent classes of health-related quality of life trajectories in middle-aged women and investigate predictors for latent classes.
Methods
This study utilized data from the 2^nd, the 4^the to the 7^the Korean Longitudinal Survey of Women & Families. The subjects included 1,351 women aged 40~45 years. The data was analyzed using latent class growth analysis and logistic regression.
Results
Two trajectories were identified for health-related quality of life in middle-aged women; ‘persistently good’ and ‘increasing’ groups. Predictors for the ‘increasing’ group were lower economic status, higher depression, and lower perceived health status.
Conclusion
This study showed that characteristics of the individual, symptom status, and health perceptions were associated with health-related quality of life in middle-aged women. It is necessary to provide effective intervention for latent classes of health-related quality of life trajectories based on physical, mental, and social factors.

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Influence of body image on quality of life in breast cancer patients undergoing breast reconstruction: Mediating of self‐esteem
Yunhee Jang, Mihyeon Seong, Sohyune Sok
Journal of Clinical Nursing.2023; 32(17-18): 6366. CrossRef

Predictors of the Fear of Falling among Elderly Women with Mild Cognitive Impairment: Jeong On Moon, Se Hoon Hong; J Korean Acad Community Health Nurs. 2022;33(1):63-73. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.63

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Abstract PDF: Purpose
The purpose of this study was to identify the predictors influencing fear of falling in community-dwelling elderly women with mild cognitive impairment (MCI).
Methods
A secondary data analysis was performed using data of 65 years or older elderly women with MCI participating in the 7th Korea Longitudinal Study of Ageing of the Korea Employment Information Service. The study subjects included 368 elderly women with MCI. For data analysis, descriptive statistics and logistic regression with complex samples were performed using IBM SPSS ver. 23.0.
Results
89.9% of the elderly women with MCI had fear of falling. There were significant factors such as religion (OR=8.85, 95% CI: 3.39~23.15), restriction of activity (OR=6.84, 95% CI: 2.14~21.90), depression (OR=0.75, 95% CI: 0.62~0.90), and MMSE (OR=1.30, 95% CI: 1.03~1.63), predicting fear of falling in community-dwelling elderly women with MCI.
Conclusion
Differentiated strategies should be developed for elderly women with MCI to decrease fear of falling and prevent falls with understanding of contributing factors. This study will provide fundamental information on programming and a policy proposal related to fear of falling for elderly women with MCI.

The Effects of Digital Literacy and Health Empowerment on Elders' Communication with Doctors: Focusing on Moderating Effect of Health Beliefs: Soon Tae An, Yu Jin Lim, Soon Dool Chung; J Korean Acad Community Health Nurs. 2022;33(1):53-62. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.53

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Purpose
This study explored the effects of the elderly group's digital literacy and health empowerment on communication with doctors, considering moderating effect of health beliefs about chronic diseases.
Methods
A one-on-one interview survey was conducted with 500 older adults in South Korea. The main variables were digital literacy, health empowerment, communication with doctors, and health belief of chronic diseases.
Results
The interaction effect between health empowerment and susceptibility, and health empowerment and perceived barrier were significant.
Conclusion
Communication with doctors greatly increased when the elders had high levels of health empowerment and low levels of susceptibility. Also, communication with doctors greatly increased when the elders had high levels of health empowerment and low levels of perceived barriers.

Citations

Citations to this article as recorded by

Digital literacy among Korean older adults: A scoping review of quantitative studies
Hun Kang, Jiwon Baek, Sang Hui Chu, JiYeon Choi
DIGITAL HEALTH.2023;[Epub] CrossRef

The Effects of ICT Enhanced Home-visit Nursing in Long-Term Care Insurance on Health-related Quality of Life among Community-Dwelling Older Adults: Keun Joo Yoo, Jin Hee Shin, Eun Hee Cho, Seok Won Hong; J Korean Acad Community Health Nurs. 2022;33(1):1-12. Published online March 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.1.1

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Purpose
This secondary data analysis study evaluated the effects of ICT enhanced home-visit nursing in long-term care insurance on health-related quality of life among community-dwelling older adults.
Methods
This study included data of 131 older adults who had experienced a pilot service for ICT enhanced home-visit nursing. ICT enhanced home-visit nursing refers to a method of sharing health records and teleconference between a visiting nurse and a doctor during the home-visit nursing services to community-dwelling older adults. Health-related quality of life and influencing factors were analyzed by t-tests, logistic regression analysis using the Stata 17/SE program.
Results
After a pilot service for ICT enhanced home-visit nursing, their health-related quality of life increased. The teleconferencing method had a significant effect on the increase in health-related quality of life.
Conclusion
The findings indicate a pilot service for ICT enhanced home-visit nursing can be applied to the domestic community-based healthcare service model in terms of health management. In the future, the advanced service model of a pilot service for ICT enhanced home-visit nursing in which subjects conduct detailed for each health problem, and a well-designed evaluation system should be developed.

Citations

Citations to this article as recorded by

Community Health Nursing During the COVID-19 Pandemic in Korea: Consequences, Challenges, and Directions
Eunjoo Kim, Ju Young Yoon, Hyori Kim
Journal of Community Health Nursing.2023; 40(2): 79. CrossRef

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